Sex, Pain, Emotions, Depression

It’s 3am as I write this blog post. Yet, I can still hear birds chirping outside my window. I’ve been stuck in a rut for the past few weeks and honestly, I don’t know what quite to do with my life at the moment. There are times when my mind is racing along at a thousand miles an hour with too many thoughts than I can humanly handle; times when every thought seems to be coated in a thick dollop of honey and crawling along. I either starve myself or binge eat on most days. My sleep cycle is off the charts, either sleeping for less than half an hour a day (or not at all), or spending sixteen hours a day “napping”. Smoking, which helps with stress release, is something that I’m indulging in like a chimney stack right now.

There’s simply too much going on in my head and I truly wish I could talk about all of those things here. I can’t, I simply can’t bring myself to do it though – partly because it involves not just me but other people close to me too, but mostly because I’m usually not comfortable talking about my mental health issues.

I wrote a blog post a couple of months ago – Depression, Zen, and barber shops – the first time that I ever publicly talked about the fact that I’m affected by depression. It felt cathartic to, in a sense, shed a skin I’d been hiding inside. But I still didn’t go too far with talking about what it’s like to actually deal with depression on a daily basis. That’s what I hope to do now, in the hope that it helps me clear my head. Helps me get out of this rut.

***

The popular conception of treatment of mental health issues is that of an ornate leather couch where you lie down on, get shown some ink splatter, and then a distinguished and bespectacled gentleman with a beard nods sadly and tells you that you want to have sex with your mom because of underlying trauma.

Credit: projectioncloud

I wish I had a fucking couch to lie on the first time I sought help for depression. Freudian psychoanalysis – to which the whole shebang of inkblot tests and lying on couches belongs – is fairly discredited in the modern mental health community. This is primarily due to advancements in the understanding of how mental illnesses actually affect people. The first point of contact when seeking help, as is with most people these days, is usually through a recommendation from a counsellor to a general practician – yes, the same doctor you see for common cold and chlamydia – where you’re evaluated for how seriously depression is affecting you.

My first appointment ever with a doctor regarding depression lasted less than ten minutes. Evaluation is done using a standard nine-question questionnaire that checks for statistically objective indicators of behaviour that have been shown to show a strong positive correlation with the occurrence of depression. I was considered a serious enough case to need medical intervention (as opposed to just counselling) and sent away with a prescription.

The truth is that modern mental health treatment is firmly based in the usage and prescription of antidepressant drugs. The whole operation runs with the ruthless efficiency of a battery chicken farm.

To this day, nobody really knows the precise mechanism of how antidepressants work.

Well, the doctors have their theories. The fundamental idea is that when a person suffers from depression, their brain chemistry is physically altered due to reduced levels of certain neurotransmitters such as serotonin and norepinephrine, chemicals that help transfer messages within the brain. From this correlation, it was found that certain substances that alter brain chemistry by increasing the levels of these select neurotransmitters over time help patients recover.

Therein lies the crux of why modern medical science places so much faith in pharmaceuticals: they have been proven time after time to be incredibly effective at solving the problems they are intended to solve. Even though the mechanism of how the drugs work may not be fully understood, in comparison to placebos, antidepressants on the market have been shown to work. But while antidepressants do work in helping a person feel better, most of them come with a host of unintended side effects. It’s just something that you learn to live with.

Credit: Kairuuinzuro

The first time I had depression, ages ago in high school, was a mild episode that was solved through talking therapy. I was so glad to have the support of my teachers back then. Then a second wave hit me: the first antidepressant that I was ever prescribed was one that a lay reader would probably be familiar with – fluoxetine, better known as Prozac. The infamous blue pill – although you’d be hard-pressed to find it in its original form as developed by Eli Lilly due to the rise of generic versions – is the line of first resort for any doctor. I went through two courses of fluoxetine for different episodes, and it worked well. I got better. I got happier. It felt good, it felt like a dark and sad chapter in my life had finally ended and I’d beaten something that I never hoped would enter my life again.

Something changed two years ago. I started my industrial placement year…and after a few months I started to hate the routine. It was this time that I came to the realisation that perhaps depression was a thing in my life that I had to deal with in the long term. I don’t attribute my work itself to causing triggering the episode, just that as a person I have issues and the onset can happen any time. This time I was diagnosed with a mild episode again and after a couple of weeks on a newer medication I was prescribed a low dosage course of fluoxetine again, since it had been so effective earlier.

For many months, it helped me maintain a modicum of normalcy and allowed me to remain productive. I impressed my academic tutor and my supervisor at work with my work and it made me feel better about myself. I enjoyed my work, I enjoyed the fact that I had money and the freedom that it gave me to travel around – just like I had done during my study exchange year in Singapore. For a short while, I wished and hoped that I would finish this course of treatment soon too and get on with final year at university when the time came.

Travertine cliffs of Pammukale. Credit: Michael Coumans

I remember the exact moment when I felt that things started going downhill again. I was backpacking in Turkey, in the town of Pamukkale – with its stunning travertine cliffs – and I was a restaurant with a friendly owner. The food was delicious and my company amazing. The owner had these cats that went around crawling around the legs of the patrons. I started petting one of them, and wave of nausea hit me. I felt like I had run head-on into a wall of sadness, and in that moment, as I was stroking that cat’s neck, I wanted to squeeze my hand around it and choke it to death. I just wanted to hurt something really, really bad. I wanted to know what it felt like to take another living being’s life. The only reason why I didn’t do it is because it was a public place and my present company wouldn’t appreciate it. (People wouldn’t appreciate me murdering a cat in the middle of a busy restaurant is what I’m trying to say.)

When I went back to the hotel room, I found that for the first time in months, I simply couldn’t sleep. I sat shivering in the balcony for hours, naked, chain-smoking, reading Michael Crichton’sSphere on my newly-gifted Kindle through faint tubelight streaming from the room. I simply lost track of time. At some point, I went into the bathroom and sat under a broken shower soaking myself in freezing cold water, crying. I rarely cry. Except this time, I did.

The rest of the trip, I went through a phase of maniacal happiness. I fucked like a rabbit; on one occasion in a dormitory, which was…weird. I got high as fuck and missed buses for cities further down my itinerary. My return to Istanbul (for my flight back) was a blur of parties every day – including making out with a guy, full-on. I met up with a member of Travel.SE, a travel site where I am a moderator and I enjoyed meeting someone on there in real life, a lot. That whole last week was just a string of unbelievably high euphoria.

And then, I came back to university, and everything came crashing down. I felt isolated and friendless: I’d been away from university for two years by then, and it felt like I didn’t really know anyone, even my old friends, that well any more. There seemed to be this huge barrier between them and me of what experiences we’d been through – and how we hadn’t been in proper touch for years – that I couldn’t seem to get over. Every conversation I had appeared to be the same. “Oh, how nice to see you after ages! Same here! How have you been? We should catch up some day.” Etcetera. I realise it’s neither my fault nor theirs – well, the onus probably was on me to make the effort to reintegrate – but the effect was still that I felt claustrophobic, socially. I plunged deeper into depression, my worst episode yet far, and I was put on an even higher dose of fluoxetine.

Antidepressants, on their own, are not habit-forming substances – such as sleeping pills or anti-anxiety drugs such as diazepam (Valium, yet another drug I’d expect readers to have heard of). They simply take a long time to work since treatment of depression takes months, if not years. But what every depressive fears is if/when they stop responding to a treatment that works for them, which is what happened with me on fluoxetine. On this higher dosage, side effects started kicking in. One of the classic side effects of fluoxetine is insomnia, and this hit me hard. Weeks into my higher dose course, I found myself unable to sleep until I reached a point where I went three days without absolutely any sleep at all. I was highly strung out and I was a group assessment exercise organised by our department for “professional development” when I had requested a callback from the medical centre. I got the call during the assessment exercise briefing and I ran out into the hallway to take the call, and just sat there crying to the nurse on the phone telling her that I hadn’t slept for days. There were no appointments – not even an emergency one – available until two days away. I spent what felt like ages crying while she told me a recipe for soothing tea – and then I composed myself and went back into the room with my coursemates. The one thing I fucking hated is publicly acknowledging that I had a defect in me. I saw it as a sign of weakness.

When a patient stops responding to a treatment they are prescribed, a whack-a-mole game of finding the next drug that works begins. That’s the path I have been on for the past six months, and it isn’t getting any better.

***

Insomnia is but one of the few common side effects of modern day antidepressants. The very first class of antidepressants that were wildly successful, discovered in the 1950s, and with which the whole pharmacological response school of treating mental illnesses began, were tricyclic antidepressants. They have mostly gone out of fashion these days since they tend to make patients mildly to violently sick, but more importantly, most of them can be fatal if overdosed on – a risk that medical professionals try to avoid.

Most widely-prescribed antidepressants, including Prozac among many others, these days belong to a class called Selective Serotonin Reuptake Inhibitor (SSRI). SSRIs work along the principle that I described earlier in this blog post, i.e., by preventing the serotonin neurotransmitter from being recaptured by neurons (a process called ‘reuptake’) which thus boosts the levels of free serotonin in the brain. The reason SSRIs are so in fashion is because they also have a positive effect on a wider range of associated disorders often affecting depressives, such as anxiety disorders, as well as the fact that many SSRIs are safer than tricyclic antidepressants when overdosed on.

Yet, as awesome as they sound, SSRIs aren’t without their fault. Every person undergoing treatment with SSRIs has to come to terms with the fact that they also need to inevitably deal with the side effects that they come with. Some of these are fairly mundane: such as dry mouth, nausea, diarrhoea, headaches, weight loss, et al – it depends on the specific antidepressant, really, and also varies from person-to-person. Yet another common drawback is that alcohol, which is a depressant, can cause rapid sedation when drunk in conjunction with antidepressants; hence, on most antidepressants or anti-anxiety pills it is strongly advised not to drink alcohol at all. The job that doctors try to achieve is to find the specific one that has the most positive effects without adversely affecting the life of the patient.

Do read what the drug notes on contraindicated substances on your medication are…or you might end up like this.

One of the weirder side effects of SSRIs, which discourages a patient from abruptly stopping a course, are “brain zaps“. Because of the mechanism in which SSRIs work, and the fact that a drug dose only lasts in the body for so long, sudden cessation of drug intake causes a sharp drop-off in serotonin levels and this manifests itself in the form of what feels like jolts of electricity in your brain. (I just had one of these a couple of days ago when I ran out of my meds and didn’t take my prescription for a couple of days.) It’s the reason why even when depression is considered to be treated, prescription of drugs isn’t stopped immediately but slowly tapered off through increasingly lower doses.

The biggest elephant in the room though for anyone using SSRIs – and this is by far one of the most common side effects – is sexual dysfunction. SSRI antidepressants commonly cause a drop-off in libido or any sort of interest in sexual activity. It only gets worse once you can get over the first step of not feeling like having sex to the actual process of having sex. Without being sexist, sexual dysfunction is something that women can deal with better since the physical manifestation of female sexual dysfunction is less apparent. Statistically, women are far likelier to suffer from depression; which leaves guys suffering from depression – like me – in an awkward position since there’s less awareness within the medical community of how to deal with such situations.

The worst that can happen to a guy on SSRIs is total or partial erectile dysfunction – and when it does happen, it can be incredibly humiliating and damaging to self-esteem, probably the last thing someone with depression needs or can deal with. Some drugs are far more susceptible to cause this and I try to stay the fuck away from them at the length of a bargepole, requesting to be switched out of them as soon as I can.

But that’s just the worst case scenario. What I’ve found to be more common with me – including my current medication, citalopram (another SSRI) – is that it causes sexual anhedonia; basically, a complete lack of any pleasure during sex. Physically, the time to orgasm varies; often I find that I can go on longer simply because I feel less sensation. That is, if I orgasm at all – which in itself can be a sexually-laden bombshell if the other person is not aware of the fact that I’m on antidepressants or what side effects they have, as it can make them feel inadequate if you just stay fucking erect feeling nothing at all. Either way – whether it’s the worst case scenario or the slightly-less-worse scenario – the point is that being on antidepressants completely sucks the pleasure out of sex and that itself is something that I’ve found to be incredibly damaging. All this when you get in the mood to have sex in the first place.

I’ve been on yet another class of antidepressants known as NaSSAs which do not typically exhibit the same sexual dysfunction side effects that SSRIs manifest. Not having to worry about whether I’d have fun during sex was incredibly liberating for my self-esteem when I was on them, but NaSSAs come with their own suite of problems which made them untenable for me. The drug I was on is mirtazapine, which was prescribed to me specifically because it causes sedation, to help with my insomnia. And for a while it did: mirtazapine knocked me out cold within half an hour of taking my dose. The problem was that at the dose that I needed for it to be effective as an antidepressant, it caused me to oversleep massively. Regardless of what time I took my medication, mirtazapine knocked me out for twelve hours or more at a time. It got to the point where I started dreading any appointments before 2pm in the afternoon. It even affected me during a job interview which was in the morning where I was just too groggy to think straight. Eventually, I stopped taking my medication altogether without consulting my doctor because I had a string of appointments one week when I really needed to get up in the morning.

My second major issue with mirtazapine is that caused me to get insanely hungry. Now, this is usually considered to be a positive side effect as depression often causes patients to drop in weight due to a loss of appetite. Yet, in my case, the complication was I have a tetchy relationship with how I perceive my body image. I used to be a skinny kid in high school, but after a bout of typhoid I went through a phase where I couldn’t do any physical activity for months on end. My weight almost doubled, an increase of 40 kg. I hated it for a couple of years, and I felt helpless to do anything about it as it felt those months with typhoid had significantly changed my daily routine. Then, over time, through a combination of better eating and partly through loss of appetite caused by depression, I shed a lot of that extra weight I had gained. I’m at a stage now where I’m comfortably within the healthy BMI range yet I’m so insecure that I want to lose 8 kg further to drop to the lower end of the BMI scale.

I have another reason for wanting to lose a lot more weight even now. I’ve gone through phases earlier – and even now – of binge-eating and purging, or as you may otherwise know it, bulimia. I typically consume 1000-1200 calories a day; then on some other days, I consume 5000-6000 calories in one sitting (the guideline daily recommendation is around 2000-2500 calories). I just stuff myself silly until I’m bursting, and then I force myself to puke it out. I spend ages hunched over the toilet bowl in our house and I lie there puking and feeling miserable. Sometimes, I eat my own vomit again as a way of punishing myself for binge-eating.

On mirtazapine, I felt hungry all the time despite how much I ate. Keeping in control of the number of calories I eat and overall either keeping my weight constant or reducing gives me a tiny sense of control in my life, and I found on this medication my anxiety levels went through the roof because I inevitably found my weight increasing due to overeating.

Despite the fact that it was actually making me feel better than ever during my waking hours, despite the fact that it didn’t have the typical sexual dysfunction side effects, mirtazapine was affecting my sense of happiness and control over my life in other ways which affected me to the extent that I stopped taking the medication without consultation. And that’s the most dangerous place a depressive can be in. I did get in touch with a doctor eventually and then started a course of treatment on another drug (a variant that belonged to the SSNRI class) – which didn’t work because it triggered an allergic reaction, so I had to be switched yet another one.

And so the whack-a-mole goes on. The thing about antidepressants is that they take time to kick in. Positive or negative effects can take at least two weeks, and more commonly, up to a month to start showing up properly so when switching around antidepressants, I go through this phase when I feel much, much worse. I might have painted a bleak picture, but without the support of antidepressants it feels much worse. Not having any control over your emotions, not being interested in the lives of your friends, not being interested in doing any work…day in and day out, day after day sucker punches you in the gut. When even you can’t think straight to get the things done that you want to do, it feels like life has no purpose. The meds become a necessary evil.

***

Say everything goes okay with your medication. You find that one drug that works for you. You might think that would be that, but the sad reality is that it’s often not. SSRI antidepressants have another common side effect: that they tend to make patients feel that their emotions are “flatlined”. They lift you out from feeling dark and gloomy all the time, they help you get up on your own feet and start functioning as normal member of society…but at the same time, for some people, it just substitutes that with a consistent sense of feeling “meh“. And although “meh” is a state one can tolerably exist in, for patients undergoing treatment for depression long-term – e.g., those whose onset factors are more complicated than something with a clear-cut trigger such as the death of someone close – dealing with this state becomes an issue too.

My life, whenever I’ve been on antidepressants, seems to have Every Day Is Exactly The Same from the Nine Inch Nails as its fucking soundtrack. On SSRIs, my typical drug response has usually resulted in this flatlining of emotions. This makes me perplexed and lost. At first, when the meds start working, I find that I can finally go ahead with my life, start meeting up with friends again and do the things that I need to get done. Yet over many months, this dulling of emotional response makes doubt creep in. “Why am I not enjoying the things that I used to any more? Why don’t I feel happy when hanging out with friends any more?” And so on. Lowering the dosage of the medication could help reduce the dulling of emotions, but it’s simply not that easy as that since a reduced dosage could mean that the medication is no longer effective at helping fight depression.

Thus continues the vicious cycle.

***

The hot water will open up your capillaries. The aspirin you just took will thin your blood…Oh and if you do decide to take the coward’s way out, make sure you cut along the tracks not across them – that’s a rookie mistake.

Humour and pain are two emotions that I find rise above this baseline of meh-ness. I tend to find random things funny; when hilarity ensues, I feel like I’m actually feeling something. Humour and pain, I think, tap into something so fundamentally basic in the human psyche that it can break through any other mental barriers.

I’m typically not suicidal, as I think of it as cop out to just quit on life. When I do have suicidal thoughts, they tend not to go beyond the ideation phase. My relationship with self-harm, on the other hand, is complicated. At times when I feel better, I can think rationally and I don’t indulge in self-harm; it’s something that I haven’t done for years now. Recently though, when I stopped taking my antidepressants and then was switched around on a couple of different ones, I found it hard to keep a grip on reality. My motivation for self-harm doesn’t stem from typical reasons why people do it – mostly, due to self-loathing – but because there are times when I feel so empty and emotionless that I’m desperate to do something – anything – to have any kind of feeling at all, even if it be pain. Within the past year, I have used various methods to achieve this: cutting myself (multiple times), scraping my tongue with a razor (this was when I started overeating and it induced guilt in me for succumbing), bleached my hair to the point that my scalp started bleeding, burnt myself with cigarettes (multiple times; it’s much harder than you see in films because the cigarette stub usually goes out on contact with flesh). Cutting myself is an act I have down to a ritual now, laying down plastic sheets so that I don’t mess my room’s carpet (I don’t want to lose my deposit).

Dexter’s plastic-wrapped kill room

The draw of self-harm for me is that when the pain sears through my head, it’s an immediate and noticeable emotion. There are memories I have from childhood that are too traumatic and when they do pop into my head, in high-definition, I would just about do absolutely anything to push them out of my head. Or to forget a particularly violent or traumatic dream I may have had. Or, if I go through a day when I feel particularly emotionless. Pain, of the kind caused by the things I’ve done, dials it up to eleven – and keeps it there. After a session of self-harm, I can actually move on and concentrate on work.

Underpass leading to Tesco

Not all pain has to be self-destructive. Self-harm is a method of release I’m driven to in my darkest times. What I usually do otherwise is sit outside in the cold; if it’s rainy or snowy, without warm clothing and bracing cold helps me have a physical reaction, an emotion. Or, walking barefoot in the middle of the night – in the snow or otherwise – to an underpass (that leads to Tesco) near my house, and then just screaming or crying until my lungs give out. I mean, the number of times that I’ve snuck out of the house and spent it outside, shivering in the cold is a count that I have lost track of by now. It helps me deal with things.

Credit: The Doghouse Diaries

My moments of self-harm and pain are intensely private to me. I don’t like reaching out to friends because I don’t do it as a way of attention-seeking, I do it as a measure of stress-relief. The decision to harm myself at any point, I see that as a fully-formed, final decision rather than an opportunity to talk to a friend so that they can reason me out of it. I would see a friend who did try to talk to me at such a time as an intrusion on my privacy. Most importantly, I hate to put my friends through a period of worrying for me because trying to deal with someone on the verge of self-harm is incredibly taxing, as I have experienced time and again when dealing with people I know who do the same. I would still happily talk to any of my friends who wants support at such a time, but only if they want it to be so.

Although someone’s intention in helping me (or anyone else for that matter) about to inflict self-harm are inarguably well-intentioned, unless it is something that you have experienced yourself it’s probably an act you won’t understand. It cannot be rationalised. It cannot be reasoned away, nor can an attempt at reverse psychology work in such a situation. This can be hard to understand and accept, especially when it’s someone you care about, but the best anyone can do is to listen to the underlying reason that is driving a person to self-harm on that occasion, rather than discuss the act itself.

***

The reason for why the way I process things the way I do can vary but one of the common ones is there’s an element of feeling neglected by parents that leads to a child seek validation elsewhere instead. I do feel that way about the relationship I feel with my parents. I don’t think I had their approval growing up as a child – and I still think I don’t have their approval. Actually, it’s more complicated than that. Rightly or wrongly, I see indifference bordering on apathy when I think about their relationship with me in my childhood. In a way, this had a positive effect inasmuch as making me more independent in my later years in life, although in a sense that independence is probably an illusion since I still enjoy the safety net of their financial support. I also get the feeling that even though my parents never valued me directly, they did use my achievements when around other people as a means of regulating their own self-esteem. That may or may not have been the case, but regardless, that is how I perceive it and that’s what affects me now. Because I feel that I’ve never had their approval, my sense of self-esteem is closely tied to how my peers and superiors (academic, mostly so far; or work superiors) perceive me. (I touched upon this aspect in my previous blog post on depression when I talked about a need for seeking attention.) The mechanism of how this works and how uneven attention from parents can affect children is largely held by the psychological community these days to be explained by “attachment theory“, that a child needs to feel attached to a caregiver for social and emotional development to happen.

I was made to realise this by my counsellor, that due to how I grew up, I have a fundamentally broken mental model of what love (not necessarily romantic), empathy, caring about others et al is all about. I consistently face pressure that I need to stand out in some way – whether it be by being good at something (or believing that I’m good at something) or being otherwise outrageous. At its very basic, it’s attention-seeking. The clash between the private and public egos results in behaviours such as defense mechanisms for anything that I see as an attack on me; it’s a question of whether I perceive it as an attack on me rather than whether it was intended that way. What I didn’t even realise is that I was often hurting people close to me because of my behaviour. I am positively obsessed with power and being in control. I get jealous of any perceived shifts in attention incredibly quickly, almost as knee-jerk reaction – and my instinctive response is tit-for-tat, albeit passive-aggressively. And – as much as pains me now to admit this, or how hurtful this may come across as to my friends, because now I know better – I often looked people around me as “toys” who only had my interest as long as I found them interesting or exciting; as interchangeable units for my narcissistic supply. (This was a two-way street, however, as I also considered that other people saw me as an interchangeable unit; basically, that no human being was truly interested in anyone else.) I derived pleasure out of tearing other people down because it made me feel better about myself and I thought that’s how the world works. When I had conversations – and I sometimes feel this way, still – I got the sense that I often wasn’t really listening, just using it as means to an end to get myself heard.

I carried on the emotional responses that I built up as a child who felt his sense of self-esteem and ego so horribly mangled later into life. Intellectually, understand what the concepts of “empathy” or “listening” or “friendship” or “love”, for instance, are; intuitively, I don’t. It’s the difference between being nice and wearing a nice sweater that I once spoke about. I’m not socially inept, because I can grasp how I should act or what I should say in social situations. I would go so far as to say that since I saw I friends as my source of narcissistic supply, since I was power-hungry, since I was emotionally disengaged, and I understood this socially, I could be deliberately manipulative. I’m not saying every interaction was motivated by that or that I didn’t genuinely feel the way I acted in all situations, but I may have done so on specific occasions, and frequently as a habit.

What I’m left dealing with is the fallout of those feelings and the realisation, now, that I am that person. Guilt. Guilt about the fact that is the person who I was, and perhaps, still am because maybe I don’t even recognise when I behave in such a manner. Soul-crushing guilt and self-loathing when I catch myself these days doing any of the things that I mentioned above and how horrible a person that makes me. Paranoia. Paranoia, partly due to depression and partly due to my underlying insecure self-esteem, that people don’t really like me. Aside from anything else, I’m an incredibly needy person and when I get an impression that I’m not getting someone’s attention, it makes me think that they don’t really like me. Fundamentally, I have massive trust issues with allowing myself to get close to people. I build a wall around my emotions and I (unfairly?) expect other people to trust me before I reciprocate. (Perhaps similar to what many people would feel like, except in my case this in conjunction with other behavioural responses that I have built up.) Doubt. Doubt about whether I actually, truly care about others. How do I know whether I truly care for or like someone when I don’t know whether I’m actually feeling something or whether I’m simply intellectualising it, when I have no baseline to compare it to? What do I do on being told that the core of my self-identity, my understanding of myself and the people around me is flawed? My brain simply goes into fritz-mode trying to figure out where I and my interpersonal relationships stand in this regard.

The goal of modern medical science is to stabilise a patient in the short-term using drugs, and to use talking therapy in conjunction with that for longer term stability. Talking therapy can come in many forms – some still stick to the older school of psychoanalysis – but the consensus these days is to stick a technique called cognitive behavioural therapy (CBT). The basic aim of CBT is to identify specific problems – perhaps more importantly to help the patient independently be aware of them, not just in the setting of a counselling session – and then formulating actionable strategies to change that behaviour. I made a comparison to mental health treatment being run akin to a battery chicken farm. The demand for psychological help these days is so high that CBT for depression has been standardised for recurring themes among depressives that it can be administered in through software.

In my case, I feel CBT both helps me and holds me back in tackling my issues. My behavioural and emotional responses, instinctively, are so warped that I need to run it through the filter of CBT to consciously check whether what I’m doing is right, and if not, correct my response. Yet, at the same time, when a core part of my self-doubt is whether I’m actually experiencing those emotions as opposed to just rationalising them, it adds to that sense of unease. Running everything through a filter makes me die a little on the inside as I wonder whether I’m better off being less spontaneous than earlier; a constant reminder of the guilt about the person I was / am. Every time the filter of CBT catches something, I tell myself that I do indeed need this and that I’m probably better off for it. Probably…

Part of therapy for me is to reconcile the concept of private and public self-image into a single consistent identity. I’m well on-board with accepting I need to do this. What I am still trying to come to terms with is how in the short-term it has made me far more insecure. Since I’m trying to actively restrain myself from avenues to feed my ego, it amplifies my underlying low self-esteem. What’s more, evaluating positive feedback through CBT makes me wary of accepting it, as it may feed my ego, I find myself increasingly paranoid about whether anyone cares for me or loves me. I’m now scared to take any signs of people taking an interest in me as them liking me.

Here’s where I have found Zen to be liberating. I know I bang on about it like an evangelical Christian, but it’s true that it has had a positive effect on me. I loved the idea of loving Zen before I actually loved Zen. It gives me the strength to believe that I cannot intellectualise, I cannot rationalise, I cannot read it in a book or hear it in a sermon…all without imposing a set of commandments or (what I consider, as an atheist) ridiculous artificial constructs of a judgemental old bearded guy sitting on a cloud. Concepts such as mindfulness and deep listening – how to truly let go and just listen to another person, and do it selflessly – are teaching me what empathy is about. It’s made me comfortable with the fact that I cannot change myself by wanting to change myself, for that in itself is being slave to a desire. Zen places supreme importance on effortlessness and instinct – which is what I feel I need to truly grasp solutions to my issues.

When people say that mental illnesses such as depression are “#firstworldproblems“, that, say, there are so many “disadvantaged people in Africa” and that I should be thankful for what I have (or anything along those lines), it really pisses me off. I see it as an apples-to-oranges comparison. The first issue is that having grown up in India, I am acutely aware of the fact that how low the awareness is about mental health issues and how terrible the support systems are. Even during my study exchange year in Singapore – a supposedly modern, “Westernised” Asian country – I found that the attitude of many people was shockingly backwards. (For what it’s worth, medical facilities and insurance coverage for them in Singapore is incredibly good.)

Maslow’s Hierarchy of Needs

There’s a theory in psychology known as Maslow’s hierarchy of needs. While it has now been superseded by other theories of explaining the human psyche, it still bears worth noting. What Maslow proposed is that humans have a pyramidal hierarchy of needs that need to be fulfilled for happy life. Lower down the ladder come basic needs such as food, water, shelter – and only once basic needs are satisfied does it free people to think about more cerebral topics such as sociological factors, the “meaning of life”, so to speak. The criticism surrounding this theory mostly stems from the ranking of these factors, and whether these would vary depending on the kind of society a person is raised in.

Nevertheless, in my opinion, I do feel that people have an internal model of what their priorities are and some needs are more important than others. Modern-day societies in developed countries (and the well-off in developing countries) make it relatively easy for the tangible, physical human needs to be fulfilled, which frees up time to think about other, intangible things. The sociological factors that contribute to stress are vastly different, even though in comparison to “disadvantaged” populations these stress factors may sound like whining. Regardless of whether you feel this a problem or not, the fact is that for people suffering from mental illnesses, the issues that prevent them from living a happy and enjoyable life – however trivial they may seem to an external viewer – are very real to them. I’m reminded of a curiously specific psychological disorder that has been observed by sociologists only in Africa known as “penis snatching“, where a patient believes their penis has been stolen. You may wonder how a person can ignore visual evidence to the contrary of a physical part of their body missing but the only thing that matters is that it feels real to a patient.

There’s a tremendous importance attached to individualistic achievement in modern society (as opposed to collectivist societies in the past), to the point this is closely tied to the sense of self-worth for many people. No wonder that incidences of mental illnesses is on the rise – both because the factors contributing to it are higher and also because there is greater recognition this is a valid ailment that can affect people. Reminiscing about the “good ol’ days” isn’t going to help, realistically; this is what our society is now and we have to find the best way to handle issues arising out of it.

***

Credit: Sarah Andersen

This brings me back to the why I wrote this blog post. The things that I have written about here are facts that precious few of my friends know about – indeed, some will come as a surprise even to them. And for the friends whom I don’t talk to about my issues, it will perhaps come as a surprise, say, that I have mental health issues or inflict self-harm because I’m wary of outwardly displaying the fact that I have these problems. I don’t have much sympathy for people who simply give up; part of getting better has to be a desire to want to get better. Social contact is very helpful: I need to constantly remind myself to get out of the house and meet friends, not necessarily to drone on about my problems but just to be in the company of those closest to me. Even then, say, after deciding to meet up with someone, I may be too washed over by soul-crushing hopelessness to summon up the strength to get out of bed to go meet them – the temptation to just bail on them is often great – but I have to remind myself that unless I do this, I won’t be getting better or doing myself any favours.

To talk about this publicly was hard, incredibly hard for me. As I said earlier, I have massive issues with trust, paranoia, and doubt – especially when I’m not clear about them in my own head. Do I think that someone who has read this will be paranoid themselves that I may be faking caring for them or being manipulative, or generally, whether I’m just faking being happy when going through depression? I don’t know the answer to that. I genuinely don’t want to be that person and I’m try my best not to be. But I’m also aware that my instinctive emotional responses are not going to change overnight – although by this point it has been months since I’ve working away at changing this. I count myself incredibly lucky to have friends who’ve stuck with me and care for me despite everything. I’ve also been blown away by the amount of support I have received from my university in helping me deal with my issues, it makes me feel that there’s at least some people in a position of authority who do care about my well-being.

I’m taking a page out of Paul Carr‘s book – literally – as he’s one my favourite authors and role models in life, who had an alcoholism problem that he dealt with by quitting publicly through the website ispauldrinkingagain.com. To quote:

When I decided to stop, I wrote an open letter on my blog, explaining that I had a serious problem with alcohol and asking for the support of those around me. Posting on Facebook or Twitter for just your friends would work just as well. If you’re worried about your professional reputation if you “come out” as an addict, you might want to consider sending a group email to a dozen or so people you trust. Believe me, word will get around. The key is for people you encounter on a day-to-day basis to be aware that you have a problem and are trying to fix it. Those people are the ones who will be your greatest allies in quitting.

By doing this, I hope to hold myself responsible publicly, in case I ever slip-up. I know my private / public egos aren’t going to vanish into thin air, but I can use those very traits to constantly remind myself that people are possibly aware of the problems I have and I cannot hide in the anonymity of knowing I can get away with it. I’ve had this duality of friends who knew / friends who didn’t, and that itself, I think – maintaining a public self-image and a more private, closed-off self-image was hurting me. While I have been relatively successful from letting my problems affect me in work or academic life, I get the feeling that when it comes to friendships and relationships I have let my struggle come to define me – and I don’t want it be that way.

What I have also realised over the past year or so is that there’s an immense amount of stigma surrounding mental illnesses. Friends that I know who also suffer from various mental disorders feel ashamed or paranoid of discussing what they are going through because they are worried about people being judgemental. And you know what? I’m tired of hiding. I’m tired of feeling ashamed, feeling that there’s a defect in me. I’ve gradually gotten more comfortable with talking about the issues that I’m going through, and I feel that the more openly that people talk about such issues – even potentially embarrassing ones – the better off everyone will be. I enjoy writing and instead of letting all these thoughts stew in my head, the process of writing all this down has helped me think clearer about where I stand on my dealing with the issues I have.

I get the sense that friends who haven’t faced mental health issues or not known anyone who’s had one also find it hard, understandably, to wrap their heads around what it is like to go through it. Depression is far more common than you’d think; within my friend circle, I’ve been surprised by the number who have somehow been affected in their lives by it. It’s hard for people to get how it can be difficult to find the motivation to get out of bed, to eat, to socialise. Talking through the process of how depression, self-harm, and my personality disorder issues affect me on a day-to-day basis – if you’ve stuck with reading it this far! – will perhaps give people reading this an insight into what it’s like.

And if you have a friend or someone close to you who’s facing mental health issues, here’s my advice: don’t give them advice. You don’t have to nor should you need to feel compelled to. That is a job for certified medical professionals to determine what their issues are and how to best deal with them. Mental health issues are unlike everyday problems that you may discuss with others about, since depressives have a fundamentally different way of processing the world around them. What you can do is just listen to them and make them feel comfortable enough to do so since it can be incredibly tough for someone to open up. That itself can be unimaginably therapeutic, for someone with depression to know that they have friends willing to listen to them. Depression makes you feel so hopeless that they may not even make the effort to talk to you about it, so you often have to draw them out.

Sometimes, a throwaway “How are you doing?” comment reminds depressives that they have people who care for them and that they have things in life to live for. Emotional support can be as simple as that.

Related

3 Comments

On the Turkish restaurant cat thing: Do you think it was subconscious jealousy? Were you jealous of the cat for receiving attention and affection, and thus wanted to kill it? Because it strongly reminded you of what you (or you thought you) didn’t have?